Renal Lithiasis Treatment with Ureterorenoscopy: Single center experience

  • Luísa Cerqueira Serviço de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Rui J Cerqueira Serviço de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Paulo Dinis, Prof. Dr. Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Urologia, Hospital de São João, Porto, Portugal
Keywords: Kidney Calculi, Treatment Outcome, Ureteroscopy, Urolithiasis


Introduction: In this study, we evaluated the initial results of this procedure in our hospital, aiming to evaluate retrograde intrarenal surgery efficacy and safety and possible success predictors of this technique.

Material and Methods: After collecting data from the medical records and imaging studies of all patients undergoing retrograde intrarenal surgery in 2014 e 2015 at Centro Hospitalar de São João, and applying our exclusion criteria, we analyzed the data of 138 patients (total of 179 retrograde intrarenal surgery). The primary outcomes of our study were the immediate success rate, assessed by the surgeon’s perception intraoperatively, and postoperative success rate, assessed by image control. Residual lithiasis was considered significant in the presence of calculi > 3 mm.

Results: The overall success rate was 67.0%, considering the surgeon’s perception. Considering the image control, the success rate was 66.7% for calculi smaller than 150 mm2 and located outside the ICG, but smaller in other locations or bigger calculi. In the univariate analysis, stone burden, calculi number and location were statistically significant predictors of retrograde intrarenal surgery success.

Conclusion: Location in the ICG was considered a predictor of retrograde intrarenal surgery failure and, in this location, RIRS was more effective for calculi < 150 mm2; this differenced was not encountered for calculi outside the ICG. It is a safe intervention, which allows a staged use.


1. Turk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. European Association of Urology Guidelines on Urolithiasis. 2016 [consultado 2016 Dez 26]. Disponível em:
2. Alatab S, Pourmand G, Howairis M, Buchholz N, Najafi I, Pourmand M, et al. National Profiles of Urinary Calculi A comparison Between Developing and Developed Worlds. Iran J Kidney Dis. 2016;10:51-61.
3. Elmansy H, Lingeman J. Recent advances in lithotripsy technology and treatment strategies: A systematic review update. Int J Surg. 2016;36:676-80.
4. Ullah A, Zubair M, Khan N, Malik A. Frequency and Factors Effecting Non Clearance of Lower Pole Renal Stones. J Ayub Med Coll Abbottabad. 2015;27:384-7.
5. De S, Autorino R, Kim F, Zargar H, Laydner H, Balsamo R, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015;67:125-37.
6. Donaldson J, Lardas M, Scrimgeour D, Stewart F, MacLennan S, Lam T, et al. Systematic review and meta-analysis of the clinical effectiveness of shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous
nephrolithotomy for lower-pole renal stones. Eur Urol. 2015;67:612-6.
7. Assimos D, Krambeck A, Miller N, Monga M, Murad M, Nelson C, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016;196:1153-60.
8. Assimos D, Krambeck A, Miller N, Monga M, Murad M, Nelson C, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196:1161-9.
9. Medina Jellendt E, Pérez-Castro Ellendt E. Ureteroscopy for the treatment of Urinary Stones. Past, present and future. Arch Esp Urol. 2014;67:591-604.
10. Lim S, Jeong B, Seo S, Jeon S, Han D. Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean J Urol. 2010;51:777-82.
11. Bai Y, Wang X, Yang Y, Han P, Wang J. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones up to 2 cm in patients with solitary kidney: a single centre experience. BMC
Urol. 2017;17:9.
12. Karakoc O, Karakeci A, Ozan T, Firdolas F, Tektas C, Ozkaratas S, et al. Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm. Turk J Urol.
13. Schoenthaler M, Wilhelm K, Katzenwadel A, Ardelt P, Wetterauer U, Traxer O, et al. Retrograde intrarenal surgery in treatment of nephrolithiasis: is a 100% stone-free rate achievable?. J Endourol. 2012;26:489-93.
14. Kruck S, Anastasiadis A, Gakis G, Walcher U, Hennenlotter J, Merseburger A, et al. Flow matters: irrigation flow differs in flexible ureteroscopes of the newest generation. Urol Res. 2011;39:483-6.
15. Portis A, Laliberte M, Holtz C, Ma W, Rosenberg M, Bretzke C. Confident intraoperative decision making during percutaneous nephrolithotomy: does this patient need a second look?. Urology. 2008;71:218-22.
16. Cho S. Current status of flexible ureteroscopy in urology. Korean J Urol. 2015;56:680-8.
17. Berardinelli F, Cindolo L, De Francesco P, Proietti S, Hennessey D, Dalpiaz O, et al. The surgical experience influences the safety of retrograde intrarenal surgery for kidney stones: a propensity score analysis. Urolithiasis.
18. Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, et al. The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy:
a single-center experience. Urology. 2012;80:524-8.
19. Merigot de Treigny O, Bou Nasr E, Almont T, Tack I, Rischmann P, Soulié M, et al. The cumulated stone diameter: a limited tool for stone burden estimation. Urology. 2015;86:477-81.
20. Lipkin M, Ackerman A. Imaging for urolithiasis. Curr Opin Urol. 2016;26:56-62.